The Clinical Risk Management Analyst will lead reviews of clinically related Compliance Line calls and inmate complaint letters, perform clinical chart reviews, update Compliance Line software and create documented responses to patient care complaints. The CRMA will generate trends and outliers for the corporate Continuous Quality Improvement Committee and assist the Professional Liability Department in review of medical records.
- Lead the investigation of clinical patient care complaints (via Compliance Line or Inmate Letters)
- Maximize use of internal sources (such as InGauge, PeopleSoft, electronic health records) to conduct reviews
- Work with Region and Site Leadership in review of patient care complaints
- On a monthly basis conduct random, detailed reviews of patient care complaints to include evaluation of medical records
- Update compliance software, including essential communications through completion of each case
- Generate a documented response for Clinical Leadership
- Assist the Professional Liability Claims Department in medical reviews
- Work closely with the Patient Safety Officer to track and trend clinical sentinel events that become legal claims or suits, as well as legal claims that were identified as a high risk during the sentinel event review process
- Work with the Associate Patient Safety Officer and Compliance Specialist on development of a clinical compliance dashboard
- Assist in the completion of special projects and initiatives on an as needed basis
- Experience Level : Registered nurse (RN) with minimum 5 years clinical and correctional healthcare experience. 1-3 years of Risk Management experience required.
- Tools and Technology : Administrative skills including strong computer skills (Microsoft Office applications) and database entry/tracking skills.
- Certificates and Licenses : Registered Nurse (RN) active license.
- Language Ability : Requires excellent communication skills and ability to work with multiple levels within the organization including site, regional and corporate HR, Operations, Clinical, Legal and Risk Management.
- Work Environment : Office environment with occasional travel to regional offices, client and/or vendor sites.
Prison inmates can't really shop around for health plans, but depending on where they are held, they may have access to Correctional...